Despite considerable research and development efforts, the problem of infections related to biomedical devices and implants persists. Bacteria evidently can readily colonize surfaces of synthetic materials, such as those used for the fabrication of catheters, hip and knee implants, dental implants, and many other devices. Infections linked to implant devices are a serious hospital problem and very often are a major cause of implant failure (Shi et al., Int J Artif Organs. 2008 September; 31(9):777-85; Zhao et al., J Biomed Mater Res B Appl Biomater. 2009 October; 91(1):470-80; Vasilev et al., Expert Rev Med Devices. 2009 September; 6(5):553-67). As the growing colony encapsulates itself with a protective exocellular bacterial polysaccharide layer, the biofilm becomes much harder to combat than circulating bacteria (Vasilev et al., Expert Rev Med Devices. 2009 September; 6(5): 553-67). According to Ratner (UW Today Dec. 14, 1999), once the bacteria get on the device, they are extremely difficult to remove and very resistant to treatment and It can take 100 times the concentration of an antibiotic to kill the bacteria when they are attached as it takes to kill them when they're free. The reason may be a protective biofilm that bacteria produce after they become established. When that happens, often the only way to treat the infection is to remove the device from the patient. The key to stopping infections, then, lies in killing bacteria that come near the device before they form an attachment.
A number of strategies have been developed for the modification of implant or implant surface to inhibit bacterial adhesion and growth, including the incorporation of Na, K and CI compounds (Mari'a et al., 2012; Uwe et al., 2005), nitric oxide (Nablo B J et al., 2005), antibiotics such as gentamicin, cephalothin, carbenicillin, amoxicillin, cefamandol, tobramycin and vancomycin (Stallmann H P et al., 2006; Stallmann H P et al., 2006; Bohner M et al., 2000; Zhao L et al., 2009; Zhao L et al., 2009; Akif et al., 2008; Helen et al., 2010; A. Dion et al., 2005), silver and chitosan nanoparticles (Huiliang et al., 2010; Volker et al., 2003; Ewald A et al., 2011; Shi Z et al., 2006), TiO2 (Lingzhou et al., 2011; Bogdan et al., 2009), ion implanted copper and silver (N. Matsumoto et al., 2009; Jayesh et al., 2008), etc., and a number of review articles have been published (Vasilev et al., Expert Rev Med Devices. 2009 September; 6(5): 553-67; Cao and Liu, Wiley Interdiscip Rev Nanomed Nanobiotechnol. 2010 November-December; 2(6): 670-84; Chaloupka et al., Trends Biotechnol. 2010 November; 28(11):580-8. Epub 2010 Aug. 18). The proposed antibacterial implants include polymeric systems (Alt et al, Biomaterials Volume 25, Issue 18, August 2004, Pages 4383-4391; Shi et al., Biomaterials Volume 27, Issue 11, April 2006, Pages 2440-2449; Marks et al., The Journal of Bone and Joint Surgery. American Volume 1976, 58(3): 358-64), metallic systems (Visai et al., Int J Artif Organs. 2011 September; 34(9): 929-46; Heidenau et al., J Mater Sci Mater Med. 2005 October; 16(10): 883-8; Fiedler et al., Int J Artif Organs. 2011 September; 34(9): 882-8; Cao et al., Biomaterials. 2011 January; 32(3):693-705), Kazemzadeh-Narbat M et al., 2010; Yoshinari M et al., 2001; Yoshinari M et al., 2010), and ceramic systems (Gbureck et al., Biomaterials. 2005 December; 26(34):6880-6; Kim et al., 2007, Key Engineering Materials, 330-332, 791; Bohner et al., Journal of Pharmaceutical Sciences Volume 86, Issue 5, pages 565-572, May 1997).